Pelvic Congestion Syndrome affects nulliparous and post-menopausal women, and the treatment of internal iliac vein reflux is critical: A retrospective cohort study looking at treatment outcomes following Pelvic Vein Embolisation.

Objective To identify the effects of patient risk factors and pelvic venous reflux (PVR) patterns on treatment outcomes of Pelvic Vein Embolisation (PVE) for Pelvic Congestion Syndrome (PCS).

Methods We performed a retrospective cohort review assessing population, intervention, comparison and outcomes (PICO) for women undergoing PVE for PCS January 2017–January 2021. We identified 190 patients who had completed both questionnaires and who had given consent for their information to be used for research (Median age 46, IQR 40-52) – 110.The distribution of pathological pelvic venous reflux found on transvaginal duplex ultrasound (TVDUS) was analysed for all patients. Pre- and post-procedure symptom burden scores were studied using a standardised questionnaire protocol. We used inferential univariate non-parametric statistics to describe our data.

Results 190 cases were reviewed; 62.6% (119/190) premenopausal, 11.1% (21/190) perimenopausal and 25.3% (48/190) postmenopausal; 10.1% (19/188) nulliparous. There was a statistically significant improvement in all symptoms and the appearance of varicosities on TVDUS post-PVE (p<0.05). The locations of veins requiring embolisation were analysed; 82.8% (154/186) required embolisation of at least one internal iliac vein tributary and ovarian vein embolisation. Age, parity, menopausal status and previous laparoscopy did not affect symptom improvement (p>0.05). No significant complications were identified.

Conclusions PVE is an effective treatment for pelvic pain due to PCS. Our results highlight the importance of internal iliac vein reflux as an important predictor in diagnosis and management. PCS should not be limited as a diagnosis for multiparous women of childbearing age as a significant proportion of patients who benefited from PVE were either nulliparous and/or postmenopausal.

Strong, S. M., Cross, A. C., Sideris, M., & Whiteley, M. S. (2022, November 14). Pelvic Congestion Syndrome affects nulliparous and post-menopausal women, and the treatment of internal iliac vein reflux is critical: A retrospective cohort study looking at treatment outcomes following Pelvic Vein Embolisation. https://doi.org/10.31219/osf.io/9g3yb